‘Silent Hypoxemia’ in COVID-19

Hypoxemia is a condition in which there is a decrease in the partial pressure of oxygen in the blood. As oxygen levels in the blood begin to drop, a person may experience shortness of breath, a condition known as dyspnea. If blood oxygen levels continue to fall, the person’s organs may shut down and the condition becomes life-threatening.

Many individuals with COVID-19 have been observed to be apparently functioning without serious issues or even shortness of breath despite low blood oxygen levels. This baffling phenomenon is called “silent hypoxemia” or, as the media coined it, “happy hypoxemia”.

With the increasing number of studies and growing medical knowledge on COVID-19, the mystery of silent hypoxemia is being unraveled. New research suggests that silent hypoxemia in people with COVID-19 can be explained by long-established principles of respiratory science.

A healthcare provider typically first measures oxygen levels with a pulse oximeter. Researchers point out that “while a pulse oximeter is remarkably accurate when oxygen readings are high, it markedly exaggerates the severity of low levels of oxygen when readings are low.”

They also noted that the brain may not immediately recognize that blood oxygen levels have dropped until oxygen falls to very low levels, at which point a patient typically experiences shortness of breath. In addition, more than half of the patients with silent hypoxemia also had low carbon dioxide levels, which researchers believe could reduce the effect of low blood oxygen levels.

Researchers believe it is also possible that the coronavirus exerts a peculiar action on how the body senses low levels of oxygen, which could be linked to the lack of smell that many COVID-19 patients experience.

According to another group of researchers, silent hypoxemia can be explained by physiologic mechanisms governing the control of breathing, breathing perception, and cardiovascular compensation. They also speculated that viral infection of the central and peripheral nervous system may have something to do with the peculiar phenomenon.

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